新型经皮经肝胆道镜取石术与腹腔镜胆总管切开取石术治疗胆总管结石的对比研究  

A preliminary clinical study comparing percutaneous transhepatic choledochoscopy lithotomy with laparoscopic choledocholithotomy for choledocholithiasis

作　　者：方天翎[1] 王宗信 刘安重[2] 刘衍民[1] 朱灿华[1] 冯钜涛[1] 李君[1] Fang Tianling;Wang Zongxin;Liu Anzhong;Liu Yanmin;Zhu Canhua;Feng Jutao;Li Jun(Department of Hepatopancreatobiliary Surgery,the First Affiliated Hospital of Guangzhou Medical University,Guangzhou 510120,China;Department of General Surgery,Center of Minimally Invasive Surgery,the First Affiliated Hospital of Guangzhou Medical University,Guangzhou 510230,China)

机构地区：[1]广州医科大学附属第一医院肝胆胰外科,广州510120 [2]广州医科大学附属第一医院微创外科中心普通外科,广州510230

出　　处：《中华肝胆外科杂志》2020年第11期854-857,共4页Chinese Journal of Hepatobiliary Surgery

基　　金：广东省科技计划项目(2014A020212515);东莞市社会科技发展(重点)项目(2018507150401634)。

摘　　要：目的:比较新型经皮经肝胆道镜取石术(PTCSL)与腹腔镜胆总管切开取石术(LD)治疗胆总管结石的临床疗效。方法:回顾分析2012年7月至2018年12月广州医科大学附属第一医院132例胆总管结石患者资料,其中男性75例,女性57例,平均年龄62.7岁。依据治疗术式分为PTCSL组( n=76)和LD组( n=56),分别行相关手术。比较两组取石成功率、结石残留率、手术时间、术后并发症等以及术后1个月结石复发、慢性胆管炎、胆管积气。 结果:PTCSL组上腹部手术史、合并胆道感染比例高于LD组,差异有统计学意义(均 P<0.05)。PTCSL组中64例患者一次性结石成功取净,9例因结石残留再次经窦道胆道镜取石,3例因穿刺失败中转为LD或开腹手术。术后发生并发症14例(19.2%,14/73)。LD组一次性结石成功取净46例,8例因结石残留再次胆道镜取石(最终残留1例),2例因术中解剖困难中转开腹手术。术后发生并发症11例(20.4%,11/54)。两组一次性结石取净率、术后结石残留率、最终结石取净率、术后并发症发生率等比较,差异无统计学意义(均 P>0.05)。PTCSL组手术时间(156±60)min,明显短于LD组(203±59)min,差异有统计学意义( P<0.05)。两组术后慢性胆管炎发生率、结石复发率比较,差异无统计学意义(均 P>0.05)。PTSCL组患者胆管积气发生率高于LD组,差异有统计学意义( P<0.05)。 结论:PTCSL和LD一样安全有效、并发症少、恢复快,特别适合有上腹部手术史、结石复发、胆道严重感染的胆总管结石患者。Objective To compare the clinical efficacy of percutaneous transhepatic choledochoscope lithotomy(PTCSL)with laparoscopic choledocholithotomy(LD)in treatment of choledocholithiasis.Methods Data of 132 patients with choledocholithiasis treated at the First Affiliated Hospital of Guangzhou Medical University from July 2012 to December 2018 were retrospectively analyzed.There were 75 males and 57 females,with an average age of 62.7 years.For 76 patients underwent PTCSL(the PTCSL group)and 56 underwent LD(the LD group).The data of the patients the success rate of lithotomy,stone residual rate,operation time,postoperative complications and stone recurrence,chronic cholangitis,and acute cholangitis 1 month after operation were compared between the two groups.Results The ratio of upper abdominal operation history and biliary tract infection in the PTCSL group was higher than that in the LD group,and the difference was statistically significant(both P<0.05).In the PTCSL group,the calculi were successfully removed in 64 patients in one treatment session,while residual calculi were removed through subsequent sinus choledochoscopy in 9 patients.In the remaining 3 patients,the residual calculi were removed with LD or laparotomy operations.Postoperative complications occurred in 14 patients(19.2%,14/73).In the LD group,the calculi were successfully removed in one session in 46 patients while in 8 patients the residual calculi were removed by choledochoscopy(1 patient still had residual calculi after choledochoscopy).The remaining 2 patients underwent open surgery due to anatomical difficulties.Postoperative complications occurred in 11 patients(20.4%,11/54).There were no significant differences between the two groups in the one-off stone removal rate,postoperative stone residual rate,final stone removal rate and postoperative complication rate(all P>0.05).The operation time of the PTCSL group was(156±60)min,which was significantly shorter than the LD group(203±59)min(P<0.05).There was no significant difference between the t

关 键 词：胆总管结石病 腹腔镜 胆总管切开取石 胆道镜 

分 类 号：R657.4[医药卫生—外科学]